Efficacy of Risperidone for Prevention of Postoperative Delirium in Cardiac Surgery

This randomised, double-blinded, placebo-controlled study was primarily aimed to evaluate the potential of risperidone to prevent postoperative delirium following cardiac surgery with cardiopulmonary bypass and the secondary objective was to explore clinical factors associated with postoperative delirium. One-hundred-and-twenty-six adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomly assigned to receive either 1 mg of risperidone or placebo sublingually when they regained consciousness. Delirium and other outcomes were assessed. The confusion assessment method for intensive care unit was used to assess postoperative delirium. The incidence of postoperative delirium in the risperidone group was lower than the placebo group (11.1% vs. 31.7% respectively, P=0.009, relative risk=0.35, 95% confidence interval [CI]=0.16-0.77). Other postoperative outcomes were not statistically different between the groups. In exploring the factors associated with delirium, univariate analysis showed many factors were associated with postoperative delirium. However multiple logistic regression analysis showed a lapse of 70 minutes from the time of opening eyes to following commands and postoperative respiratory failure were independent risk factors (P=0.003, odds ratio [OR]=4.57, 95% CI=1.66-12.59 and P=0.038, OR=13.78, 95% CI=1.15-165.18 respectively). A single dose of risperidone administered soon after cardiac surgery with cardiopulmonary bypass reduces the incidence of postoperative delirium. Multiple factors tended to be associated with postoperative delirium, but only the time from opening eyes to following commands and postoperative respiratory failure were independent risk factors in this study.

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Faculty Opinions recommendation of Modifiable and nonmodifiable risk factors for postoperative delirium after cardiac surgery with cardiopulmonary bypass.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3003956.2682055 ◽

2010 ◽

Author(s):

Jose Biller ◽

Sara Hocker

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Postoperative Delirium

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Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

10.21203/rs.3.rs-37538/v1 ◽

2020 ◽

Author(s):

Xiao-huan Ma ◽

Fang Yin ◽

Jie Zhang ◽

Meng-yun Peng ◽

Hong Guan ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Oxygen Therapy ◽

Laboratory Data ◽

Male Gender ◽

High Flow ◽

Binary Logistic Regression Analysis ◽

Hypoxemic Respiratory Failure ◽

Factors Associated ◽

Independent Risk Factors

Abstract Background Acute hypoxemic respiratory failure is prevalent in severe Coronavirus Disease 2019 (COVID-19). High-flow nasal canula (HFNC) is currently the most common ventilation strategy for COVID-19 patients with respiratory failure. This study is to analyze the risk factors associated with high-flow nasal canula (HFNC) oxygen therapy failure in patients with severe COVID-19.Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male gender and PaO2/FiO2 were independent risk factors significantly associated with HFNC failure (both, P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male gender and decreased PaO2/FiO2 were independent risk factors associated with HFNC failure in severe COVID-19 patients.

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Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

10.21203/rs.3.rs-41316/v2 ◽

2021 ◽

Author(s):

Xiao-Huan Ma ◽

Meng-Meng An ◽

Fang Yin ◽

Jie Zhang ◽

Meng-Yun Peng ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Oxygen Therapy ◽

Laboratory Data ◽

High Flow ◽

Binary Logistic Regression Analysis ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Factors Associated ◽

Independent Risk Factors

Abstract Background: Acute hypoxemic respiratory failure is prevalent in severe Coronavirus Disease 2019 (COVID-19). High-flow nasal canula oxygen therapy (HFNC) is currently one of the most common ventilation strategies for COVID-19 patients with respiratory failure. This study is to analyze the risk factors associated with HFNC failure in patients with severe COVID-19.Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased C-reactive protein, neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male, PaO2/FiO2 and SOFA scores were independent risk factors significantly associated with HFNC failure (all P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male, low PaO2/FiO2 and SOFA scores were independent risk factors associated with HFNC failure in severe COVID-19 patients. However, studies with larger sample sizes or multi-center studies are warranted.

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Modifiable and Nonmodifiable Risk Factors for Postoperative Delirium After Cardiac Surgery With Cardiopulmonary Bypass

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2010.01.003 ◽

2010 ◽

Vol 24 (4) ◽

pp. 555-559 ◽

Cited By ~ 78

Author(s):

Christoph S. Burkhart ◽

Salome Dell-Kuster ◽

Melanie Gamberini ◽

Ariane Moeckli ◽

Martin Grapow ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Postoperative Delirium

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Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review

Cardiovascular Psychiatry and Neurology ◽

10.1155/2015/370612 ◽

2015 ◽

Vol 2015 ◽

pp. 1-12 ◽

Cited By ~ 41

Author(s):

Nikil Patel ◽

Jatinder S. Minhas ◽

Emma M. L. Chung

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Cognitive Decline ◽

New Technologies ◽

Perioperative Risk ◽

Factors Associated ◽

Perioperative Risk Factors ◽

Postoperative Cognitive Decline

Modern day cardiac surgery evolved upon the advent of cardiopulmonary bypass machines (CPB) in the 1950s. Following this development, cardiac surgery in recent years has improved significantly. Despite such advances and the introduction of new technologies, neurological sequelae after cardiac surgery still exist. Ischaemic stroke, delirium, and cognitive impairment cause significant morbidity and mortality and unfortunately remain common complications. Postoperative cognitive decline (POCD) is believed to be associated with the presence of new ischaemic lesions originating from emboli entering the cerebral circulation during surgery. Cardiopulmonary bypass was thought to be the reason of POCD, but randomised controlled trials comparing with off-pump surgery show contradictory results. Attention has now turned to the growing evidence that perioperative risk factors, as well as patient-related risk factors, play an important role in early and late POCD. Clearly, identifying the mechanism of POCD is challenging. The purpose of this systematic review is to discuss the literature that has investigated patient and perioperative risk factors to better understand the magnitude of the risk factors associated with POCD after cardiac surgery.

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Genital injuries in women reporting sexual assault

Sexual Health ◽

10.1071/sh03004 ◽

2004 ◽

Vol 1 (1) ◽

pp. 55 ◽

Cited By ~ 45

Author(s):

Cheryn M. Palmer ◽

Anna M. McNulty ◽

Catherine D'Este ◽

Basil Donovan

Keyword(s):

Risk Factors ◽

Sexual Assault ◽

Multiple Logistic Regression Analysis ◽

Multiple Logistic Regression ◽

Factors Associated ◽

Independent Risk Factors ◽

Type Frequency ◽

Court Proceedings ◽

Genital Injury ◽

Genital Injuries

Background: The likelihood of genital injury following sexual assault remains unclear. Genital injury related to sexual assault is often an issue in court proceedings, with the expectation that injuries will be found in 'genuine' cases. Conviction rates are higher when the complainant has genital injuries. Objectives: To determine the type, frequency and severity of genital and non-genital injuries of women following alleged sexual assault and, in addition, to determine factors associated with the presence of injuries. Methods: The assault records and forensic examination findings of 153 consecutive women who attended a sexual assault service in Newcastle, Australia, between 1997 and 1999 were reviewed. All of the women were examined within 72 hours of the assault. Associations were sought between victim and reported assault variables and the presence of injury using multiple logistic regression analysis. Results: Of the women, 111 (73%) were aged under 30 years and only 4% were over 50 years. Penile–vaginal penetration was the most common type of sexual assault (86%). Non-genital injuries were found in 46% of the women examined (mostly minor) and genital injury in only 22%. Genital injury in the absence of non-genital injury was rare (3%). Independent risk factors for the detection of non-genital injuries were reported threats of violence (OR 5.7, 95% CI; 2.2–14.6). Risk factors for genital injury were the presence of non-genital injury (OR 19, 95% CI; 6.0–63.0), threats of violence (OR 3.7, 95% CI; 1.5–8.9) and being over the age of 40 years (OR 5.6, 95% CI; 1.6–20.3). If the alleged assailant was known to the woman this was protective for both non-genital (OR 0.3, 95% CI; 0.1–0.5) and genital (OR 0.4, 95% CI; 0.2–0.9) injury. Conclusions: The presence of genital injury should not be required to validate an allegation of sexual assault, particularly in the absence of non-genital injuries.

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